Insuring Your Health

1. Insuring Your Health #9

2. Learning Goals

3. Importance of Health Insurance

4. Exhibit 9.1

5. Health Insurance Plans Private Health Insurance Plans

6. Traditional Indemnity Plans

7. Managed Care Plans

8. Types of Managed Care Plans Health Maintenance Organizations (HMOs)

9. Types of Managed Care Plans Health Maintenance Organizations (HMOs)

10. Blue Cross/Blue Shield Plans

11. Exhibit 9.2 Most Common Types of Health Plans

12. Government Health Insurance Plans Health Care Reform

13. Government Health Insurance Plans Medicare program

14. Components of Medicare Part A—Basic hospital insurance • Free for those qualified • Covers hospital room and board, other inpatient and outpatient care • Deductibles apply, amounts vary according to length of stay Part B—Supplementary medical insurance • Optional coverage available for a premium if eligible for Part A • Covers doctors, surgeons, lab tests, x-rays, and other services, including some home health care

15. Medicaid

16. Workers’ Compensation Insurance • Premiums paid by employers for workers injured on the job • State administered; coverage varies • Coverage includes: • Medical, rehabilitation expenses • Disability income • Lump-sum payments for death, dismemberment • Second-injury funds

17. Health Insurance Decisions

18. Medical Expense Coverage and Policy Provisions Hospitalization

19. Medical Expense Coverage and Policy Provisions Surgical expenses • Pays cost of surgery in or out of hospital • Not all procedures are covered such as cosmetic or experimental surgery Physician expenses • Pays physician fees for nonsurgical hospital care • Includes consultation with specialists and lab tests

20. Medical Expense Coverage and Policy Provisions Major medical insurance • Broad coverage for illnesses and catastrophic injuries • May have lifetime limits Comprehensive major medical • Combines major medical with basic hospital, surgical and physicians expense coverage • Through group plans with low deductible

21. Dental services: Medical Expense Coverage and Policy Provisions

22. Other Types of Health Plans

23. Policy Provisions of Medical Expense Plans Deductible • Initial amount not covered • Determined on a calendar-year or per-incident basis Participation (Coinsurance): • Company pays a portion of medical expenses after a deductible • Plan may include a stop-loss provision to cap out-of-pocket expenses

24. Policy Provisions of Medical Expense Plans Internal limits • Limits amount paid on certain items to usual, customary, and reasonable charges even if cost is within the norms Coordination of benefits • Eliminates double payment when coverage provided under more than one policy

25. Terms of Coverage

26. Cost Containment Provisions for Medical Expense Plans

27. Long-Term Care Insurance Involves the delivery of medical and personal care, other than hospitalization, to persons with chronic medical conditions in nursing home, assisted living community, or patient’s home

28. Do You Need Long-Term Care Insurance?

29. Long-Term Care Provisions and Costs Type of care Eligibility requirements Services covered Waiting periodDaily benefits RenewabilityBenefit duration Preexisting conditions Inflation protection Premium levels

30. Typical Provisions in Long-Term Care Insurance Policies

31. How to Buy Long-Term Care Insurance

32. Disability Income Insurance Provides families with weekly or monthly payments to replace income lost when insured is unable to work due to an illness, injury or disease

33. Estimating Disability Income Insurance Needs

34. Disability Insurance Provisions and Costs Definition of disability - “own occupation" Benefit amount and duration Probationary period Waiting period Renewability Other features - (COLA), guaranteed insurability option, and waiver of premium